Will You or a Family Member Have Access to Long-Term Care Insurance and LTC Services When you Need Them?

by Leroy O. Stone

If you do not have long-term care insurance at this time and you are assuming that it will be available for purchase as part of your risk management strategy going forward get ready for the prospect that you may find few companies in the business of selling this type of insurance, or you may denied the insurance after a health examination. Forbes has just published an article entitled “What's Killing the Long-Term Care Insurance Industry”, along with some interesting reader comments. One knowledgeable commentator claims that the article exaggerates how bad is the state of the industry; but its specific ‘facts’ of recent industry developments are not challenged.

One dimension of the relevant risk management challenge was not touched in this article. If you or a family member has this type of insurance and are ready to purchase long-term care service using that insurance, you may find even today that the supply this type of service may be seriously lacking in quantity or quality or both. That's today.

What about tomorrow, as the baby boomers’ parents move into advanced ages and the older baby boomers reach into ages where breakdowns in functional capacity have increased probability and, when they occur, might require long-term care services? Are we facing a situation in which the available supply of service will be vastly outstripped by the demand, or at least the unmet needs, due to the sheer size of the well-matured segment of our population?

If the normal sources of supply of this type of service are far too small to meet the future demand, irrespective of the proportion of the demand that can be paid by long-term care insurance, then those disabled baby boomers and their parents who will require long-term care would need to find themselves in local community settings where older families have made effective arrangements to share caring work on an unpaid basis. If across the nation arrangements for this type of mutual informal support at the community level cannot be evolved as you go forward, there may emerge a full-blown personal care crisis -- that is, a vast number of people with serious suffering because they cannot get long-term personal care.

Surely, as we look around the world we might find enough suitably trained persons to more than fill the demand; but will they be allowed to immigrate into the country in sufficient numbers to provide that service on the scale needed? And even if they are allowed to immigrate into the country to provide that service, on what scale will persons needing the service have the income required to pay for it?

Such questions flood the mind when you think about an especially poignant set of situations that arise when the need for long-term personal-care services develops because an individual has fallen into a state of major neglect of basic self-care actions, and that sometimes even to the point of harming themselves. A substantial literature on this subject is now emerging, and links to some of the relevant articles are provided below.

Thinking of this matter from the perspective of risk management issues and practices, there are two distinct phases of risk management pertinent here. First, neglect of basic self-care often arises, according to the literature, in situations where individuals have fallen into a prolonged depression associated with social isolation. To proactively manage the probability of falling into that state, persons need to be mindful of and attentive to the strengths of their social networks much earlier on in their lives since a strong social network cannot be built overnight. This matter should probably considered urgent for those who are facing the loss of key family members, either due to family breakdown or death. Let us put this important point bluntly: the media and the financial services industry spend all their time trying to tell you how much you need to save for retirement; but you need to be equally careful about nurturing a strong support network because you are likely to badly need that in later life, and that even if at earlier stages of your life course you had a wonderful time living alone.

The second stage of risk management thinking arises in connection with the family or persons upon whose shoulders have fallen to caring work associated with helping a family member who has reached a worrying stage of self neglect or even self harm. Risk management here involves arrangements designed to share that burden. Living in the right type of community setting some of the sharing may come from non-relatives through informal supporting arrangements set up in advance in anticipation of the emergence of individual or family situations where the need for help becomes critical. ( Such arrangements could probably be facilitated by the emergence of community time banks -- certified time credits are logged against the names of particular individuals that provide unpaid services to others in advance of the days when they may need such services themselves. At first this type of community support mechanism looks like a crazy idea; but it doesn't seem so crazy when you stop to realize that the vast majority of what we consider to be our financial wealth is nothing more than a set of entries again our names in computer hard disk drives at the appropriate money-dispensing institutions.)

Probably a very small proportion of families are faced with this particular type of caring burden; but it is worthy of some focus here because it almost certainly involves long-term-care arrangements. What follows are some links to portions of the relevant literature along with brief synopses of main points in these articles. (Use the Internet links shown following the word “Source” to get more details in each case.)

•❑ Self-neglect among older persons is a major concern among their loved ones and caregivers

"Self-neglect is a serious and growing problem among older adults," writes Kristen L. Mauk, PhD., in a 2008 article in Rehabilitation Nursing, Vol. 36, No. 2, March/April. She emphasizes that while caregivers often seek to promote autonomy among people, important dilemmas arise when "poor health behaviors put them or others at risk for negative consequences". [ Source: http://www.rehabnurse.org/uploads/files/rnj335.pdf ]

•❑ Age-related illness and self-neglect

Illnesses that reduce persons’ capacity to perform basic tasks of daily living are statistically associated with displays of self-neglect among the elderly. This finding comes from a study done at the University of Texas Health Science Center in Houston. It was reported in the September 2007 issue of the American Journal of Public Health, co-authored by Dr. Carmel Bitondo Dyer and others at the Center. The study deal with data for “538 people who were referred to an adult protective service agency because they weren't taking care of themselves. Their average age was 75.6 years and 70 percent were women.” Agreeing that self-neglect is a common problem among those of advanced age, the authors report that "Lack of family or social support was the most common finding in this study … .” [ Source: http://www.reuters.com/article/2007/08/09/us-self-neglect-idUSCOL95384320070809 ]

•❑ A key risk factor that points to self-harm among older persons

Persons who say they are experiencing multiple negative life problems are at slightly heightened risk of deliberately harming themselves, according to a 2008 article by Camilla Haw, and Keith Hawtona at the Centre for Suicide Research, Department of Psychiatry, Oxford University. They examined data for over 4,000 clients of the general hospital in Oxford from 1993 to 2000. Using a “Suicide Intent Scale”, they found that “Patients with high intent more frequently experienced psychiatric and social isolation problems than those with low intent. Females with high intent more frequently reported bereavement or loss and eating problems.” They advocate more focus on “individually tailored” interventions by service deliverers. [Source : http://www.sciencedirect.com/science/article/pii/S0165032707006556 ]

•❑ A pattern of repetition in self-harm

There is a substantial probability of a pattern of repeated self-harm among those who begin that behaviour, according to a study of a cohort of over 900 persons conducted by several MDs in Taiwan, and published in The British Journal of Psychiatry in 2010. “A total of 970 individuals who had self-harmed were recruited from a community-based suicide behaviour register system … [ and they] were followed-up until December 2005 to examine the risk of repeated self-harm and independent predictive factors.” They found that repetition is most likely in the 1st year following its outbreak. Noting a relatively high prevalence of self-cutting and self-poisoning with drugs, the authors cite female gender as a risk factor. [ Source: http://bjp.rcpsych.org/content/196/1/31.long ]

•❑ Age differences in risk factors for repetition of self-harm

Reporting that there are few studies of self harm within the older population, researchers leading the Manchester Self-Harm Project have found that the pattern of risk factors among middle-aged persons is quite different from that among the elderly. Published in the June 2011 issue of the Journal of Clinical Psychology, the paper by Oude Voshaar R. C., Cooper, J., Murphy, E., Steeg, S., Kapur, N., and Purandare, N.B., points to a “need for age-specific interventions beyond the scope of psychiatric care alone.” Theirs was “a prospective cohort study that gathered data from 1997 to 2007. These data were “for individuals presenting with self-harm at emergency departments of 3 large hospitals in North West England.” [ Source: http://www.ncbi.nlm.nih.gov/pubmed/21733475?dopt=Abstract ]

This study supports another recently publicized by JournalWatch on August 1, 2011. Entitled “Self-Harm and High Suicide Risk: Age Makes a Difference”, the JournalWatch summary reports that “Among adults with first episodes of self-harm, older people have more hopelessness and more physical illness and may require a different treatment approach.” [Source: http://psychiatry.jwatch.org/cgi/content/full/2011/801/3# ]